Healthcare Provider Details

I. General information

NPI: 1063561272
Provider Name (Legal Business Name): ASSOCIATES IN CLINICAL PSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WEST MONROE ST
PLYMOUTH IN
46563
US

IV. Provider business mailing address

1801 SHORE ACRES RD
LAKE BLUFF IL
60044
US

V. Phone/Fax

Practice location:
  • Phone: 574-936-8004
  • Fax: 574-936-8225
Mailing address:
  • Phone: 630-355-1433
  • Fax: 847-295-9841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC ALLEN ZACKHELM
Title or Position: PRESIDENT
Credential: PHD
Phone: 630-355-1433